KVHS Daycare Application

Session applying for:

Parent(s)/ guardian(s) Name:

Email:

Child’s Name:

Age:

Sex:

Male

Female

Date of Birth:

Home Telephone:

Daytime Telephone:

Cellular Telephone:

Address:

Emergency Contact Information

Name:	Relation:
Daytime Phone Number:

Medical History Related to Daycare participation: (allergies, etc.):

Names of people who have permission to pick up your child (This person will be required to present identification when they pick up the child.):

Does your child have permission to go on short walks around the school property?

Yes
No

Any additional information you would like to include.

By clicking submit I am stating that the information I have given is true and accurate and I agree to the terms outlined by the KVHS Daycare.